Cost Effectiveness and Resource Allocation最新文献

{"title":"Clinical effectiveness and economic evaluation of acupoint injection for the treatment of primary insomnia: a systematic review and network meta-analysis.","authors":"HuiYan Zhao, Mi Hong Yim, Ho-Yeon Go, Jung-Hee Jang","doi":"10.1186/s12962-026-00758-5","DOIUrl":"10.1186/s12962-026-00758-5","url":null,"abstract":"<p><strong>Background: </strong>Primary insomnia is a highly prevalent sleep disorder that significantly affects quality of life. Acupoint injection (AJ), a traditional therapy that combines pharmacological and acupuncture effects, has been increasingly applied in clinical practice. However, evidence of its efficacy and economic value is lacking. This study determined the clinical effectiveness of AJ and established the relative ranks of AJ-related therapies for the treatment of primary insomnia.</p><p><strong>Methods: </strong>The clinical effectiveness and cost-effectiveness of AJ-related therapies for primary insomnia were evaluated through a systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs). We searched 11 electronic databases for relevant studies published up to June 10, 2025. The Pittsburgh Sleep Quality Index (PSQI) and effective rate were used as outcome measures. The quality of included studies was assessed using the Risk of Bias 2.0 tool. Pairwise meta-analysis and NMA were performed using RevMan 5.4 and R, respectively. The cost-effectiveness of the interventions was subsequently determined based on regional intervention costs.</p><p><strong>Results: </strong>Twenty-four randomized controlled trials involving 1,851 participants were included in the meta-analysis. AJ combined with manual acupuncture (MA) significantly reduced PSQI scores based on the results of the pairwise meta-analysis and was among the most effective interventions based on the results of the network meta-analysis. The cost-effectiveness analysis revealed that AJ combined with MA was associated with better outcomes at modest additional costs, as indicated by the favorable incremental cost-effectiveness ratio (ICER) values for PSQI improvement and additional responders.</p><p><strong>Conclusions: </strong>This study is the first to comprehensively synthesize evidence on the clinical effectiveness and cost-effectiveness of acupoint injection for primary insomnia. AJ combined with MA significantly improves sleep quality and may be a cost-effective and safe adjunctive therapy within the context of traditional medicine practice. It may be a feasible treatment option for primary insomnia. However, this conclusion should be validated through future studies due to the limitations of the quality of the literature. Further high-quality RCTs with standardized economic evaluations are warranted to confirm these findings.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of optical coherence tomography-guided percutaneous coronary intervention for patients with complex coronary artery lesions in China: a markov model-based study.","authors":"Xiaoying Jiang, Yujing Zhou, Yunsheng Chen, Tongyin Yan, Shuzhang Du, Haiqiang Sang","doi":"10.1186/s12962-026-00744-x","DOIUrl":"10.1186/s12962-026-00744-x","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the cost-effectiveness of Optical Coherence Tomography (OCT)-guided versus coronary angiography-guided Percutaneous Coronary Intervention (PCI) within the Chinese healthcare system, exploring its economic value for patients with complex coronary artery lesions.</p><p><strong>Methods: </strong>A Markov model simulated a cohort of 10,000 patients aged 65 with coronary heart disease over a lifetime horizon (20 years). Adopting a healthcare system perspective, the study compared OCT-guided versus angiography-guided PCI strategies. Model parameters integrated 2-year follow-up data from the OCCUPI trial, clinical parameters from a meta-analysis of 6 RCTs, the Chinese National Reimbursement Drug List (2025), and health utility values for the Chinese population. A 5% discount rate was applied for the cost-utility analysis. The primary outcome was the Incremental Cost-Effectiveness Ratio (ICER).</p><p><strong>Results: </strong>This study compared the cost-effectiveness of OCT-guided versus angiography guided PCI over short-term (within-trial) and long-term (20 years) horizons. In the short term (1 year), the ICER for OCT versus angiography was substantially high at 2,154,501.65 CNY/QALY, indicating a lack of cost-effectiveness advantage. However, in the lifetime simulation, OCT demonstrated significant cost-effectiveness. When using transition probabilities from the OCCUPI trial, the ICER markedly decreased to 6,815.47 CNY/QALY, indicating strong cost-effectiveness. When using transition probabilities from the meta-analysis incorporating multiple studies, the ICER was 42,374.86 CNY/QALY, below the willingness-to-pay threshold of one times China's per capita GDP (99,665 CNY), also demonstrating cost-effectiveness. Subgroup analyses revealed that the economic advantage of OCT was more pronounced in patients with diabetes, unprotected left main disease, small vessel disease, and multivessel disease. Sensitivity analyses confirmed the robustness of these findings. The results indicate that OCT-guided PCI exhibits a typical \"high initial investment, long-term significant benefit\" profile, representing a cost-effective interventional strategy over a lifetime horizon.</p><p><strong>Conclusion: </strong>Within the Chinese healthcare system, OCT-guided PCI demonstrates favorable cost-effectiveness for patients with complex coronary artery lesions. Its higher initial costs are offset by long-term health gains, supporting its value for broader adoption.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13202912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How accurate should a precision medical test be to meet cost-effectiveness.","authors":"Ermo Chen, Xinyue Zeng, Huajie Jin","doi":"10.1186/s12962-026-00752-x","DOIUrl":"10.1186/s12962-026-00752-x","url":null,"abstract":"<p><p>Precision medical tests play a critical role in tailoring treatment plans to individual patients and optimizing medical resource utilization. This paper establishes a quantitative model to analyze the relationship between the accuracy of a precision medical test and its cost-effectiveness. Two theoretical lower bounds on test accuracy are proposed to be required for a testing strategy to be considered cost-effective. The first bound ensures that the intervention matched to a test result remains locally optimal for the reported patient class, thereby satisfying a local efficiency criterion. The second bound ensures that the testing strategy yields a higher expected net monetary benefit for the entire population compared to no testing, satisfying a global efficiency criterion. A special case analyzing sensitivity and specificity for binary test results illustrates these thresholds intuitively. Numerical simulations support these theoretical findings. The results illustrate how accuracy requirements depend on class prevalence, treatment benefits, and test costs, and may serve as a preliminary screening criterion for further evaluation.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13312563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Costs of venovenous extracorporeal membrane oxygenation (VV-ECMO) and its potential contribution to quality-adjusted life years: a mixed-methods study protocol.","authors":"Marisa Haupert, Christian Burisch, Oliver Schöffski, Timur Sellmann","doi":"10.1186/s12962-026-00755-8","DOIUrl":"10.1186/s12962-026-00755-8","url":null,"abstract":"<p><strong>Background: </strong>Venovenous extracorporeal membrane oxygenation (VV-ECMO) is a mechanical life support modality used in patients with severe respiratory failure. Despite rising case numbers worldwide, costs are substantial, while patient-centered outcomes, particularly survival and quality-adjusted life years (QALYs), remain uncertain. High complication and mortality rates also persist. Limited financial budgets, human resources, and treatment capacities in healthcare systems require critical evaluation of whether continued use of this resource-intensive intervention at the current scale is sustainable and ethically justifiable. This study aims to provide further insight into this issue and to support healthcare decision-making by offering a structured economic and ethical framework for evaluating VV-ECMO, particularly regarding resource allocation, proportionality of costs, and the justification of its use in high-cost intensive care.</p><p><strong>Methods: </strong>This mixed-methods study consists of two parts. Part A includes two systematic literature reviews. The first examines total and daily in-hospital costs per patient, as well as outcomes measured in QALYs for adult patients supported with VV-ECMO across multiple countries between 2005 and 2024. The second aim is to identify established interventions with confirmed QALY gain that can subsequently be used as comparators for VV-ECMO. Part B evaluates the results according to the principles of medical ethics: beneficence, non-maleficence, autonomy, and justice.</p><p><strong>Discussion: </strong>Given limited financial, personnel, and treatment capacities in healthcare systems, the question of how highly resource-intensive interventions such as VV-ECMO can be justified has increasing clinical, economic, and ethical relevance. By linking cost-related outcomes with a structured ethical evaluation, this study aims to contribute to a more differentiated discussion of whether and under which conditions VV-ECMO may be considered proportionate and justifiable within resource-constrained healthcare settings. Expected challenges include data availability and quality, differences in reported charges versus costs, and variation in healthcare systems, reimbursement structures, and national decision-making frameworks. These factors represent inherent limitations of international comparisons. The analysis is therefore intended as a comparative and contextual assessment rather than a formal cost-effectiveness evaluation within a single national reimbursement framework, particularly as no officially established uniform willingness-to-pay threshold per QALY exists in Germany.</p><p><strong>Clinical trial registration: </strong>Not applicable. This study does not involve interventional clinical research. The protocol was registered on the Open Science Framework ( https://osf.io/24ky5 ).</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"24 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Budget impact of expanded hemodialysis versus high-flux hemodialysis using real-world evidence in Colombia.","authors":"Mauricio Sanabria, Jasmin Vesga, Angela Rivera, Peter Rutherford, Hoover Quitian, Bengt Lindholm","doi":"10.1186/s12962-026-00754-9","DOIUrl":"10.1186/s12962-026-00754-9","url":null,"abstract":"<p><strong>Background: </strong>Expanded hemodialysis (HDx) using medium cut-off dialyzers has been associated with lower all-cause hospitalization rates compared to conventional high-flux hemodialysis. Reductions in hospitalization frequency represent a major driver of healthcare expenditures and may contribute to improved budget sustainability in resource-constrained healthcare systems. The objective of this study was to estimate the budget impact of adopting HDx from the perspective of the Colombian healthcare system, using real-world evidence.</p><p><strong>Methods: </strong>A budget impact analysis was developed according to the ISPOR guidelines using a tool built in Microsoft Excel. Clinical effectiveness inputs were derived from a multicenter cohort study (COREXH-E), including an extended dataset and a difference-in-differences analysis to estimate the effect of HDx on hospitalization rate while accounting for unobserved confounding. Cost inputs were obtained from national administrative databases, including hospitalization costs and bundled dialysis payments. The analysis adopted a one-year time horizon and a third-party payer perspective representing the Colombian healthcare system. Budget impact scenarios were evaluated, assuming HDx market uptake rates of 5%, 10%, 20%, and 50%. Deterministic and probabilistic sensitivity analyses were performed to assess parameter uncertainty.</p><p><strong>Results: </strong>Adoption of HDx was associated with net cost savings for the Colombian healthcare system across all uptake scenarios. Under hospitalization rates observed in the real-world cohort, estimated annual savings ranged from USD 472,756 to USD 4,727,564 as HDx uptake increased from 5% to 50%. In scenarios reflecting higher hospitalization rates observed in the general Colombian hemodialysis population, annual savings ranged from USD 1,344,401 to USD 13,444,010. Cost savings were primarily driven by reductions in hospitalization frequency. Probabilistic sensitivity analysis showed that HDx was cost-saving in 97.8% of simulations.</p><p><strong>Conclusions: </strong>This study suggests that expanded hemodialysis could result in short-term cost savings for the Colombian healthcare system by reducing hospitalization-related costs without increasing dialysis expenses.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13317427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic burden of hemodialysis among patients with chronic kidney disease in Dar es-Salaam region in Tanzania - a cross-sectional study.","authors":"Grace Mallange, Oddvar Martin Kaarbøe, Alphoncina Kagaigai, Novatus Tesha, Jonathan Mngumi, Jamila Didi, Amani Thomas Mori","doi":"10.1186/s12962-026-00749-6","DOIUrl":"10.1186/s12962-026-00749-6","url":null,"abstract":"<p><strong>Background: </strong>Chronic Kidney Disease (CKD) is a major public health problem with increasing morbidity and mortality, and with high cost to patients and the health care system. This study aims to estimate the patient's cost, incidence of catastrophic health expenditure, and factors influencing the cost of hemodialysis in Dar es-Salaam region, Tanzania.</p><p><strong>Methods: </strong>This cross-sectional study included 437 CKD patients who were on hemodialysis in eight centres. Data was collected in two rounds between March and April 2023 and April to May 2024 by interviewing patients or caregivers using a pre-tested questionnaire. Cost data were collected in Tanzanian shillings (TZS) and converted to 2024 US dollars ($), using the exchange rate of 1$ = 2,314 TZS. Data was analyzed with Stata 18. A mixed-effects generalized linear model (GLM) with gamma distribution was used to assess the association of independent variables with hemodialysis cost. The incidence of catastrophic health expenditure (CHE) was calculated as the proportion of households whose annual spending on hemodialysis treatment exceeded 10% or 25% of their average annual household income.</p><p><strong>Results: </strong>The average annual cost of hemodialysis was $3,099. Direct medical costs contributed 49.1% ($1,523), direct non-medical costs 20.8% ($645), and indirect costs 30.1% ($931). The economic burden was four times higher among patients who solely paid in cash compared to those who were fully insured i.e. $7,9301 versus $1,958. Only 40% of patients reported they were still working after starting hemodialysis; however, on average, they missed about 12 working days every month. Proportion of 0.91 patients incurred annual hemodialysis treatment costs that exceeded 10% of their annual income, while 0.77 patients experienced treatment costs that exceeded 25% of their income. The patients' cost of hemodialysis was significantly associated with having a monthly income greater than $217, solely paying in cash, receiving full or partial exemption, having partial insurance, undergoing hemodialysis for two to three years, and attending more than one hemodialysis session per week.</p><p><strong>Conclusion: </strong>The economic burden of hemodialysis is particularly high among patients who pay out-of-pocket compared to those with health insurance coverage, contributing to a significantly higher incidence of catastrophic health expenditure among uninsured patients (91% vs. 77%). Therefore, the government must implement policies that protect patients without health insurance, as they remain at substantial risk of being driven into impoverishment and poverty.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Financial strain beyond coverage: assessing out-of-pocket costs for dialysis care in chronic kidney disease at a tertiary care centre in Central India.","authors":"Senthilkumar Ramasamy, Snehlata Gahlawat, Abhiruchi Galhotra, Vinay Rathore","doi":"10.1186/s12962-026-00753-w","DOIUrl":"10.1186/s12962-026-00753-w","url":null,"abstract":"<p><p>PURPOSE: The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) was launched in 2018 to reduce financial risk arising out of catastrophic health expenditure. Chronic dialysis is one of the costliest treatments and PMJAY has emerged as one of the most important method of subsidizing dialysis allowing many patient to afford dialysis. In fact dialysis has become the most sought after treatment under PMJAY. Despite subsidies from PMJAY, patients often have out of pocket expenditure in accessing dialysis services. OBJECTIVES: To assess the out-of-pocket expenditure in accessing dialysis services among chronic kidney disease patients in Central India. METHODS: This hospital-based cross-sectional study was conducted among stable hemodialysis patients attending a tertiary care teaching hospital in the state of Chhattisgarh. A semi-structured questionnaire was used to collect the socio-demographic and clinical details. The participants were asked to provide details of out-of-pocket expenditure, including the charges of direct medical expenses and indirect medical expenses. Costs were reported as median values with interquartile range. RESULTS: A total of 99 hemodialysis patients took part in this study. Median age was 43 (IQR: 34–54) years and the median distance travelled to avail dialysis was 30 (IQR:7-85.8) kilometres. Thirty-three patients who initially received dialysis at a private setup subsequently transitioned to a public dialysis facility, with a mean interval of 19 months. 25 (25.3%) received PMJAY (Ayushman card) subsidies at the initiation of hemodialysis, but in the later part, this proportion increased to 78 (78.7%) during the course of ongoing dialysis services. The monthly overall out-of-pocket expenditure was INR 17058.3 (IQR: 11922.9–26672.9). Three-fourths have borrowed money to meet the healthcare expenses. CONCLUSION: The majority of the maintenance hemodialysis patients visiting our centre availed the Ayushman scheme, but still needed other sources to meet their financial healthcare costs. An expanded comprehensive health insurance is needed to address the substantial OOPE borne by the hemodialysis patients on travelling and medications. </p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13267519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of a brief cognitive-behavioral outpatient rehabilitation program for patients with post-COVID-19 condition within a pragmatic randomized controlled trial.","authors":"Tom Farmen Nerli, Joel Selvakumar, Ingar Heier, Tone Langjordet Johnsen, Vegard Bruun Bratholm Wyller, Torbjørn Wisløff","doi":"10.1186/s12962-026-00748-7","DOIUrl":"10.1186/s12962-026-00748-7","url":null,"abstract":"<p><p>BACKGROUND: Post-COVID-19 condition is an ongoing public health concern, and the lack of established treatments increases health care utilization. Recent evidence suggests that cognitive and behavioral approaches reduce symptoms and improve functional capabilities. This study reports the cost-effectiveness of a brief outpatient cognitive-behavioral rehabilitation program compared to care as usual in non-hospitalized patients with post-COVID-19 condition. METHODS: An economic evaluation based on a randomized clinical trial was conducted from a health care sector perspective. Health care utilization was charted using a self-developed questionnaire administered immediately after the intervention as well as 12 months after inclusion. Health-related quality of life was measured using the EQ-5D-5L inventory at inclusion and follow-ups and valued using the Norwegian tariff. We used multiple imputation with chained equations to impute missing data. To illustrate analysis of uncertainty, bootstrapping was performed. To account for correlation between costs and quality-adjusted life years (QALYs), we conducted seemingly unrelated regression. Costs and QALYs were summarized over the entire 12-month follow-up period. RESULTS: Over 12 months, analysis yielded an incremental QALY gain of 0.056 (95% CI: 0.024 to 0.077) and an overall cost reduction of NOK − 20,682 (95% CI: -47230 to -1614) per patient receiving the brief outpatient rehabilitation program compared to care as usual. A total of 100% of simulations indicated that the intervention was cost-effective. CONCLUSION: A brief outpatient rehabilitation program based on a cognitive and behavioral approach was cost-effective compared to care as usual in non-hospitalized patients with post-COVID-19 condition. Further investigations of comparable clinical trials within other health care systems are warranted. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05196451, 19th January 2022. </p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13244644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Which surfactant is cost-effective in Neonatal Respiratory Distress Syndrome?","authors":"Golara Nikakhtar, Zahra Karimi Majd, Zahra Ghasemi, Negin Akhtari, Nazila Yousefi","doi":"10.1186/s12962-026-00735-y","DOIUrl":"10.1186/s12962-026-00735-y","url":null,"abstract":"<p><p>Neonatal Respiratory Distress Syndrome (NRDS) is the most common cause of hospitalization and preterm birth and one of the leading causes of death in newborns. The main intervention is surfactant therapy. This study aimed to determine the cost-effectiveness of Calfactant compared to Beractant and Poractant alfa in treating preterm infants with RDS in Iran. A two-state decision tree model was developed based on RDS disease pathways, assuming that neonates had been admitted to the NICU using one of the aforementioned surfactants. Efficacy as life years gained (LYG) and transition probabilities between states were extracted from international RCTs. Costs are presented in US dollars, and the incremental cost-effectiveness ratio (ICER) is presented from the Iranian healthcare system perspective. To evaluate the model’s robustness against data uncertainties, the study conducted both deterministic (one-way and two-way) and probabilistic sensitivity analyses, including a Monte Carlo simulation, using varied input ranges and distributional modeling, with results visualized through tornado plots and scatter plots. From the Iranian healthcare system perspective, in RDS preterm neonates, Calfactant was cost-effective versus Beractant. However, it is not cost-effective compared to Poractant alfa.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13214448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147677710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individual-level prediction models of societal costs and health-related quality of life in pediatric cerebral palsy: a population-based study from Spain.","authors":"Diana Marcela Nova-Díaz, Paloma Arana-Rivera, Eduardo Sánchez-Iriso, Sergio Aguilera-Albesa, Diego Rivera","doi":"10.1186/s12962-026-00743-y","DOIUrl":"10.1186/s12962-026-00743-y","url":null,"abstract":"<p><strong>Background: </strong>Individual-level economic models more effectively capture the heterogeneity of clinical severity, caregiving needs, and social context in pediatric cerebral palsy (CP). We developed and validated predictive models to estimate how clinical, sociodemographic, socioeconomic, and health-related quality-of-life (HRQoL) factors affect disaggregated categories of societal costs. We then examined how these factors and cost components influence HRQoL outcomes for children with CP and their caregivers in Spain.</p><p><strong>Methods: </strong>Using data from 148 children with CP and their caregivers in a Spanish population-based registry, we estimated annual costs from a societal perspective. Cost components included healthcare, informal care, public subsidies, and out-of-pocket expenses (adjusted to €2023). We applied generalized linear models (GLMs) to model costs: one-part GLMs with gamma distribution and log link for most categories, and two-part models for intensive rehabilitation therapies (logistic regression for the probability of any cost, followed by a GLM for the positive costs). Child and caregiver HRQoL were modelled using ordinary least squares (OLS) and Tobit regression, respectively. Predictive performance was assessed via mean absolute error (MAE), root mean squared error (RMSE), and mean error (ME).</p><p><strong>Results: </strong>Greater functional impairment in children was the primary driver of higher costs and lower HRQoL. Socioeconomic factors, including caregivers' job loss due to caregiving, low household income, and lower social class, predicted higher out-of-pocket spending and worse caregiver HRQoL. Latin American family origin was associated with higher total illness costs but lower informal care costs. Use of non-standard therapies (reported by 64% of families) increased overall societal costs and was linked to marginally better child HRQoL.</p><p><strong>Conclusions: </strong>Individual-level, disaggregated models can inform value-based healthcare assessments by capturing the complexity of pediatric disability. Our findings underscore the importance of caregiver burden and informal care in determining costs and well-being. We provide a web-based Shiny calculator to enable practical application of these predictive models.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13224597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147663213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}